Developed by Shawkat Jahangir NCD icddr,b © 2019                                                                         Information provided by Dr. Noshin Farzana NCD icddr,b

Theme 3:
Stroke and other Neurological disorders

List of Abstracts

  1. Stem Cell Research In Bangladesh: Neurosurgical Perspective

  2. Ischemic Stroke Subtyping, Based On Vascular Imaging

  3. Prevalence and Risk Factors of Stroke in Bangladesh: A Nationwide Population Based Survey

  4. Tranexamic Acid For The Treatment Of Significant Traumatic Brain Injury

  5. Cerebral Revascularization By EC-IC Bypass In Ischemic Conditions Of Different Etiological Mode

  6. Hemorrhagic stroke from ruptured intracranial AVM: Microsurgical management

  7. Easy Z Score Imaging Systems  In Brain Perfusion SPECT  For The Assessment Of Severity Of AD

  8. Micro Onco-Surgical Management Of Glomus Jugulare: Early Experiences

  9. Demographic Profile Of Writer’s Cramp Patient And Its Effect On Job Continuation

  10. Vitamin D Status And The Determinants Of Its Deficiency In Admitted Acute Ischemic Stroke Patients Of A Tertiary Care Hospital In Bangladesh

  11. Evaluation Of High Density Lipoprotein Cholesterol (Hdl)Concentrations Among Elderly Ischemic Strock Patients

  12. Determinants Of Stroke Among Adult Male (30-65 Years) Of Bangladesh-A Hospital Based Case-Control Study

  13. Guillain-Barré Syndrome In Bangladesh- An Overview




Stem Cell Research In Bangladesh: Neurosurgical Perspective

Sukriti Das

Associate Professor, department of Neurosurgery, Dhaka Medical College Hospital, Dhaka, Bangladesh


Purpose: Spinal cord injury, is certainly a debilitating and devastating condition in terms of itseffect on a person`s physical, mental, familial as well as social life. Spinal cord injury (SCI)causes sensory loss, motor paralysis and autonomic difficulties. Complete spinal cord injury with ASIA Grade A patients remains untreated and neglected in our country since long back. Here wedescribe an effective strategy for the treatment of complete spinal cord injury by autologousbone marrow derived stem cell. Material and Method: The study was conducted in the Neurosurgery department, Dhaka MedicalCollege and Hospital, Dhaka, Bangladesh from January, 2016 to January, 2019. The studypopulation was 25 Patients with complete spinal cord injury (ASIA Grade-A). Total 60 ml of autologous bone marrow was aspirated and processed to prepare 6-7 ml of bone marrowaspirate concentrate (BMAC) which was transplanted at the site of cord injury. Bony alignmentwas done by decompression and stabilization. Post-surgical physiotherapy and regular follow upwas given. Result: Surgical outcome was assessed by ASIA Grading and subjective autonomicimprovement. Among 25 patients, 12 patients (48%) improved by one grade, 8 patients (32%)improved by two grade, 3 patients (12%) improved by three grade, 2 patients (8%) did not showany improvement of any grade as because their follow-up period was less than 6 months. 23patients (92%) noticed sensory/motor improvement, 19(76%) patients noticed bowelimprovement and 16 patients (64%) noticed bladder improvement by some extent. Conclusion: Stem cell therapy is safe and effective. Steady and focused progress in stem cellresearch will open the door for many disable patients in the country like Bangladesh.




Ischemic Stroke Subtyping, Based On Vascular Imaging

Dr. Md. Shahidullah1. Dr. Nahid Sultana, Dr. Subash Kanti Dey. Dr. Anis Ahmed

1 Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Dhaka National Medical College


Introduction:  Most strokes and stroke related death and disability happened in low and middle income countries. There are differences in the clinical presentation, risk factors, and pathophysiology of different ischemic stroke patients. To plan an efficient evaluation and treatment of individual patient of ischemic stroke, the clinician should be familiar with the sub typing of ischemic stroke patients and the risk factors analysis of different etiology. Vascular imaging is necessary for classifying the patient. Method: This is a hospital based prospective study in Bangladsesh. Within the time frame of 2014 March to 2017 November; we analyzed 1978 patients of ischemic stroke within 10 days of symptom onset. Among them 877 patients have been selected for this study to whom brain imaging (CT/ MRI), vascular imaging (MRA, DSA), ECG and echocardiography have been done. We did subtyping according to TOAST criteria. Result:  The mean age of patients was 60.5±11 years. Most patients (29.23%) belonged to the age group 51-60, followed by 23.67% from 61-70 age groups. 61.78% subjects were male and 38.22% were female. Within the classification of TOAST, we have found 41.87% of patients were in large artery atherosclerosis group, 23.83.% in small vessel occlusion group, 8.46% in cardiac embolism group, 14.38% in undetermined etiology group and 2% in other determined etiology. Among risk factors DM was found in 53.93%, hypertension in 61.1%, hypercholesterolemia in 26.74%, smoking 27.82%, previous stroke in 8.81% of patients. Conclusion: In ischemic stroke patients, large artery atherosclerosis was the most common subtype.




Prevalence and Risk Factors of Stroke in Bangladesh: A Nationwide Population Based Survey

Prof. Md Badrul Alam Mondal, Dr A T M Hasibul Hasan1, Prof. Quazi deen Mohammad

1National Institute of Neurosciences and Hospital


Introduction: There is paucity of high-quality epidemiological data on stroke in Bangladesh. Therefore, this door to door survey was conducted to estimate the prevalence and risk factors of stroke among Bangladeshi population. Methods:This population based cross-sectional study, was carried out in 64 districts from January 2018 to June 2018 among adults aged 18 years and above residing anywhere in Bangladesh. The study adopted a two stage cluster random sampling approach. The calculated sample size was 25,287. Semi-structured questionnaire was used to identify suspected stroke patients who were subsequently confirmed by consultant neurologists. Result: In the first stage, interviewers identified 561 respondents as suspected stroke through the Questionnaire for Verifying Stroke Free Status (QVSFS) system in 64 districts. In the second stage; 288 respondents were diagnosed as stroke patients by the consultant neurologists which provided a prevalence of 1.14%. The highest stroke prevalence (1.47%) were found in Mymensingh division and lowest (0.76%) in Rajshahi division. The prevalence was higher in elderly (3.01%), among male (1.36% versus 0.86%), in rural areas (1.18% versus 1.1.0%). About 79.7% patients had ischemic stroke, followed by hemorrhagic (15.7%), and subarachnoid hemorrhage (4.6%). Majority of the stroke patients had hypertension (79.2%), followed by dyslipidemia (38.9%), tobacco use in any form (37.2%), diabetes (28.8%), ischemic heart disease (20.1%). Conclusion: We found a stroke prevalence of 1.14%, the highest being in Mymensingh division. The prevalence were much higher in elderly and male population. Hypertension, dyslipidemia, tobacco use, diabetes, ischemic heart disease are the most common risk factors observed among the stroke patients.




Tranexamic Acid For The Treatment Of Significant Traumatic Brain Injury

Dr. Sukriti Das

Dhaka Medical College Hospital, Dhaka, Bangladesh


Background: Traumatic brain injury (TBI) is commonly accompanied by intracranial bleeding which may be worsen after hospital admission. Tranexamic acid (TXA) has been shown to reduce bleeding in elective surgery and there is evidence that short courses of TXA can reduce re-bleeding in spontaneous intracranial haemorrhage. We aimed to determine the effectiveness and safety of TXA along with usual conventional treatment in preventing progressive intracranial haemorrhage in TBI. Objective: Traumatic brain injury (TBI) is a leading cause of death and disability. Intracranial hemorrhage (ICH) secondary to TBI is associated with a high risk of coagulopathy which leads to increasing risk of hemorrhage growth and higher mortality rate. Therefore, antifibrinolytic agents such as tranexamic acid (TXA) might reduce traumatic ICH along with usual conventional treatment. The aim of the present study is to investigate the extent of ICH growth after TXA administration in TBI patients. Method: This is an experimental study. We enrolled 40 patients older than 16 years with mild to moderate TBI (post-resuscitation Glasgow Coma Scale (GCS) 8 to 15) who had a computerized tomography (CT) brain scan within twenty-four hours of injury and in whom there was no immediate indication for surgery. The treatment was Tranexamic acid (loading dose 1 g over 10 minutes, then infusion of 1 g over 8 hours) along with usual conventional treatment with antibiotics, analgesics, anti-ulcerants, steroids, anti-convulsant, anti-emetics etc. Result: The 20 patients allocated to usual conventional treatment with tranexamic acid (Group A) and 20 allocated to only usual conventional treatment (Group B). All patients provided information on clinical outcomes. Progressive intracranial haemorrhage was present in 3 (15%) of group A and in 12(60%) of group B. The mean total haemorrhage growth was 4.8 ml (SD 26.8) in group A and 9.1 mL (SD 29.2) in group B. New focal cerebral ischaemic lesions occurred in 2 (10%) patients in group A versus 14 (70%) in group B. There were 0(0%) deaths in group A and 4 (20%) in group B. Conclusion: It has been established that TXA, as an effective hospital-based treatment for acute TBI, could reduce ICH growth. This trial shows that TXA reduce chance of hematoma progression, reduce perilesional edema and infarction thus improve patients condition (GCS).


Cerebral Revascularization By EC-IC Bypass In Ischemic Conditions Of Different Etiological Mode

Forhad H Chowdhury1, Raziul Haque, Mainul Haque Sarker, SM Monir Hossain1,

1National Institute of Neurosciences, Dhaka Medical College Hospital, Ibn Sina Hospital, National Institute of Neurosciences, Dhaka, Bangladesh.


Background: Here we present a case series with cerebral ischemia from different etiological modes underwent EC-IC bypass with positive end results. Method:Patients in these cases series with TIA/stroke/recurrent stroke were evaluated clinically for history of TIA or recurrent/hemodynamic TIA (in rest or during work) or progressive hemiparesis/aphasia/visual disturbances or sudden hemiplegia/aphasia with subsequent significant recovery. Then the cases were evaluated radiologically for cerebral ischemia. MRI of brain was done in ischemic protocol (All images including DW, ADC, PW, DTI and MRAandMRV including neck vessels) to see cerebral ischemic zone/s (DWand PW mismatch) and intracranial or extracranial arterial stenosis. To see the arterial pathology dynamic CTA was done in all cases with MRA. When clinical features, cerebral ischemia on MRI and arterial stenosis/occlusion on angiogram were concordant with each other, only then cerebral revascularization by EC-IC bypass was done. All patient were followed up regularly clinically and radiologically. All bypass operation was done from January 2015 to March 2018. Result:Total no. of cases were 08. Six  male and 02 female. Age range 25-57. Follow up period was 48-12 months. Most common presentation was hemiparesis. Acute thrombosis of ICA with aneurysm in CS occurred in two female cases. In one case there was intractable TIA with impending major stroke where whole brain was supplied by only right-sided ICA Only high flow EC-IC bypass was done in this case. STA- MCA bypass was done in rest of the cases.  All were ambulant with static neuro-status without new stroke till last follow up. All bypass were patent till last follow up. Conclusion:In this small series cases with clinical features, cerebral ischemia on MRI and arterial stenosis/occlusion on angiogram were concordant with each other and  we found such concordances resulted positive result with cerebral revascularization.



Hemorrhagic stroke from ruptured intracranial AVM: Microsurgical management

Forhad H Chowdhury1, M Raziul Haque, Mainul H Sarkar.

Department of Neurosurgery, 1National Institute of Neurosciences and Hospital, Dhaka, bangladesh


Background:Intracranial AVM are the lesions that challenge vascular neurosurgeon in skill, knowledge and philosophy. Though there is multimodality of treatment of AVM but surgery is the treatment of choice. Here this paper is our experiences of surgical management of intra cranial AVM. Method:Data of operated cases of intracranial AVM were recorded prospectively and studied. Result:Total cases 31. Male 18 and female 13 cases. Mostly presented with hemorrhage and epilepsy. Investigations were cerebral DSA/+CTA/+MRA with CT or MRI of brain. 12 were small AVM and rest were giant AVM and high flow. One patient expired and one developed hemiparesis. Rest are in good health without neurodeficit or recurrent til last follow up. Conclusion:Intracranial AVM surgery should be properly evaluated and executed that can give the patient a better out come.




Easy Z Score Imaging Systems  In Brain Perfusion SPECT  For The Assessment Of Severity Of AD

Nasreen Sultana1, Hiroshi Matsuda2, Azmal KabirSarker3, Jasmine Ara Haque1, Rafiqul Islam4

1National Institute of Nuclear Medicine and Allied Sciences( NINMAS) , Bangabandhu Sheikh Mujib Medical University campus Dhaka, Bangladesh 2Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan 3Institute of Nuclear Medicine and Allied Sciences, Mitford, SSMC campus, Dhaka, 1100, Bangladesh  4Neurology, BSM Medical University, Dhaka, Bangladesh

Introduction : Brain perfusion SPECT (BPS) for qualitative identification of regional cerebral blood flow (rCBF) deficit was limitedly available in Bangladesh while the clinicians in major institutes of Bangladesh have been mostly using the mini mental state examination (MMSE) as a tool for screening of cognitive impairment (CI). This study attempted to explore association of MMSE scoring and Z score in patients with clinical likelihood of having Alzheimer’s disease (AD). Method: Patients with clinical likelihood of having AD on basis of MMSE score who underwent BPS using Tc-99m ethyl cysteinate dimer (ECD) from February to December 2018 were included in this study. eZIS version 3 (Mastuda et al.) was applied to BPS image DICOM data to quantify rCBF. Patients were divided into two groups on basis of MMSE score (group A, mild stage of AD = 20-26 and group B, moderate stage of AD = 10-19). Result: BPS was performed on 34 patients (M/F = 26/8) with clinically suspected AD with mean age of 61.2±10.4 years (41-90) and mean duration since clinical onset of 10.3±4.7 months (6 -24).  Mean MMSE and mean Z scores were 22.9±1.11 and 1.01±0.35 in group A (n = 18) while 17.56±0.96 and 2.62±0.53 in group B (n = 16).  There was negative correlation between MMSE and eZIS score; r = - 0.69 in group A (p = 0.002); r = - 0.58 in group B (p = 0.019) and r = - 0.93 overall (p = 0.000). Conclusion: Quantification rCBF with eZIS score was correlated with clinical MMSE scoring in patients with clinical likelihood of having AD. We propose use of eZIS as an objective adjunct to MMSE for clinicians in major institutes of Bangladesh to aid initiation of appropriate pharmacotherapy in patients with suspected AD.




Micro Onco-Surgical Management Of Glomus Jugulare: Early Experiences

Forhad H Chowdhury1, M Raziul Haque, Shamsul Islam Khan, SMNK Chowdhury

1National Institute of Neurosciences and Hospital, Dhaka Medical College Hospital, Dhaka Bangladesh,  Chittagong Medical College Hospital, Chittagong, Banfladesh


Background:Gloums tumors are very challenging tumor for a skull base surgeon due to its location, relationship with critical neuro-structures and vascularity. Material and methods:ata of operated cases of  glomus jugulare was evaluated retrogradely. Result:Total no. of cases were 11. Age range-27-53yrs. Presenting features were tinnitus, hearing loss, headache, facial and lower cranial nerve palsy and per aural bleeding. Complete excision was done in all cases.  One patient developed permanent dysphagia. One patient died from septicemia on 16th POD. Rests of the patient are leading normal life with some degree of facial paresis. Conclusion:Though indication of operation for glomus jugulare is a matter of debate, judicial courageous microsurgical management can bring happiness to the patients where surgery is indicated.



Demographic Profile Of Writer’s Cramp Patient And Its Effect On Job


Continuation

Md Ahsan Habib1, Abu Nasar Rizvi, SM Zakir Hossain

Md Ahsan Habib, Associate Professor, 1Dept. of Neurology Bangabandhu Sheikh Mujib Medical University; Abu Nasir Rizvi, Professor, Dept. of Neurology, Bangabandhu Sheikh Mujib Medical University, SM Zakir Hossain, Medical Officer, Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh.


Introduction: Writers cramp (WC) is defined as involuntary muscular contractions when the patient writes, resulting in occasional pain and difficulty in control of the pen .  It  is a focal dystonia that typically affects the hand most heavily involved in writing . Abnormal posturing of the fingers is common, and may involve the wrist, elbow and, rarely, the shoulder. Objective : To present demographic profile of writer’s cramp patient and its effect on job continuation. Method: It was a cross sectional study conducted in the department of Neurology, Bangabandhu Sheikh Mujib Medical University from May 2012 to April 2013. 47  writer’s cramp patients were included in this study. Result :  Among 47 patients, 46 were male and one female. Average age of the patients was 35.4 years. Minimum age of the patients was 16 and maximum age was 65 years. 32 patients were between the age of 21 to 40 years. Most of  the patients were suffering for duration of 3 years (27Nos). 32 patients were service holder, 9 patients were student and 6 patients were businessman. Most of the patients (32Nos) facing problem to continue job, 3 patients have to leave job due to writer’s cramp. Conclusion : Writer’s cramp causing problem to continue job.










 

Vitamin D Status And The Determinants Of Its Deficiency In Admitted Acute Ischemic Stroke Patients Of A Tertiary Care Hospital In Bangladesh

Anil-Shah1, Selim S1, Haq T1, Khan MA1, Marufa-Mustari1, Mostafahasan- Rajib1, Anil-Yadav1, Shahed-Morshed1, Faisal I‑, Ghani MH1, Hasanat MA1, Fariduddin M1

1Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.


Background:  Vitamin D deficiency is common across all age groups and may contribute to Ischemic stroke. Serum 25-hydroxyvitamin D deficiency causing ischaemic stroke has been documented in recent reportsMaterials and methods: A cross-sectional study including 73 acute ischemic patients admitted in the department of neurology, equal number of apparently healthy gender and age group matched control were recruited. All the participants were interviewed for medical history, physical measurements were taken and imaging reports confirmed the diagnosis of stroke by neurologist.  Data were collected by a pre-tested semi-structured questionnaire, clinical examination (BMI, Waist circumference, Blood pressure) and laboratory investigation [serum 25(OH)D]. With informed written consent and maintaining all aseptic precautions 3ml of venous blood was collected for serum 25(OH)D. Collected sample was assayed by High Performance Liquid Chromatography (HPLC) method. Result: About 94.74% of study population were found to have low vitamin D level, insufficiency or deficiency 38.35%  and  56.16% respectively. The mean ± SD vitamin D level of acute ischemic stroke patient was 18.68± 8.29 and of apparently healthy control was 18.07 ± 8.05. The known factors of vitamin D deficiency such as inadequate sun exposure, high BMI, advancing age, rural residence and low socio-economic status were not significantly contributing with OR(95%CI)P were 0.46(0.13 - 1.56) p=0.21, 1.45(0.63 - 3.32) p=0.38, 1.58(0.76 - 3.28) p=0.22,  0.96(0.47 - 1.94) p=0.90 and 1.16(0.54 - 2.49) p=0.70 respectively. Conclusion: There is a high prevalence of biochemical hypo-vitaminosis D in apparently healthy Bangladeshi of all age and sex groups despite adequate sunshine. There is no significant difference between mean vitamin D level between stroke and healthy population.







Evaluation Of High Density Lipoprotein Cholesterol (Hdl)Concentrations Among Elderly Ischemic Strock Patients

Dr. Kazi Jannat Ara1 ,Abu Shams,  MD Hasan Ali Masum , MD Shahidulah( Sabuj) 1 Prof.AKM Anwar Ullah1

, 1Dept of Neurology, Bangabandhu Sheikh Mujib Medical University

Anwer Khan Modern Medical College



Background: Stroke is a alarming health hazard all over the world as well as in Bangladesh and one of the leading causes of mortality and morbidity. There is a well-established inverse relation between serum concentrations of HDL cholesterol and the risk of coronary heart diseases but it is not a well-documented risk factor for stroke. Objective: To evaluate of the high density lipoprotein cholesterol(HLD-c) concentration among elderly ischaemic stroke patients. Method: This cross sectional study was conducted in Out Patient Department(OPD) stroke clinic and Indoor of the department of neurology, Bangabandhu Sheik Mujib Medical University(BSMMU), Dhaka from July 2015 to June 2016 over a period of 1 year. A total 200 patients suffering from ischaemic  stroke of age more than 60 years of both sexes were included in this study according to selection criteria. Patient with TIA, and haemorhagic stroke, Stoke after one month of onset cases and patients already on anti-lipid drugs were excluded from this Study. Result: In this study male female ratio was 1.95:1. Mean age was 68.4±8.24 years within the range of 61-95 years. Maximum incidences were occurred during activity(39.4% )or during sleep(36.65%)Seventy five(52.8%)patients had hypertension,20 (14.1%) had diabetes mellitus,10(7.0%)patients had atrial fibrillation,8(5.6%)had ischemic heart disease. Forty four(31.0%)patients had smoking habit ,mean total cholesterol was 190.7±56.0 mg/dl, mean HDL was36.9±8.4mg/dl, mean LDL was123.9±38.8mg/dl and mean Triglyceride was 175.9±70.5 mg/dl. HDL level gradually decreased according to the increment of age. Conclusion: High density lipoprotein cholesterol is low in elderly ischaemic stroke patients.



Determinants Of Stroke Among Adult Male (30-65 Years) Of Bangladesh-A Hospital Based Case-Control Study

Mir Nabila Ashraf1, 2 ,Manjura Nila1, Md. Delwer Hossain Hawlader1, Aliya Naheed2

1 North South University, Dhaka, Bangladesh , 2 icddr,b, Mohakhali, Dhaka, Bangladesh


Background: Stroke is accounted as the one of the most important factors of disability and second most common cause of death globally. In Bangladesh, the prevalence of stroke among 40years above aged is 0.3%. Due to negligence and high cost of the intervention, identification, control and prevention of the risk factors at individual and community level is very poor. Study shows that male is more prompt to develop stroke than women. Aging is also associated with stroke, though younger age people are also suffering from stroke which has not been explored in Bangladesh yet. The main purpose of this study is to determine the determinants of stroke among adult male in Bangladesh. Method: The study was conducted in Shaheed suhrawardy medical college Dhaka, within the time period of May 2018 to October 2018 of adult male aged 30 to 65 years. The sample size was 178, 89 cases and 89 controls. The participants were selected purposively. Data collection tool was face to face interview with questionnaires containing structured questions according to the objectives and variables of the study, Beck’s depression Inventory for screening depression. All data will be entered into SPSS software and will be analyzed. Result: The mean age of cases and controls were 49 ± 8 years and 50 ± 8 years, respectively. Most of the cases (73%) and controls (70%) are Muslims by religion and among the cases 36% are private job holder and 38% are businessman whereas 51% of controls are private job holders and 34 % are businessman.  Our study suggested that smoking history (OR 13.787. p=0.00), uncontrolled hypertension (OR 9.239. p=0.00), history of dyslipidemia (OR 4.526. p=0.04) and depression (OR 4.092. p=0.037) are significant predictors for stroke adjusting all the confounding factors. Conclusion: Although this study did not produce any surprising results, but our study revealed depression is one of the most important risk factors that has not been explored before. This hospital based studies emphasized the importance of prevention stoke by prohibiting the specific risk factors. A nationwide stroke survey should be more helpful to identify the regional variation and risk factors which will ultimately contribute to prevent the negative outcome of the disease.







Guillain-Barré Syndrome In Bangladesh- An Overview

Badrul Islam1,2, Zhahirul Islam1, Hubert P. Endtz1,2,3, Quazi D. Mohammad4, and Bart C. Jacobs5


1icddr,b, Dhaka, Bangladesh; 2Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands; 3Fondation Mérieux, Lyon, France; 4National Institute of Neurosciences and Hospital, Dhaka, Bangladesh; and 5Departments of Neurology and Immunology, Erasmus University Medical Centre, Rotterdam, The Netherlands


Abstract: Guillain-Barré syndrome (GBS) is the most common acute immune mediated neuropathy with a yearly incidence of 1.2–2.3 cases per 100 000 population. The incidence of GBS is high in Bangladesh. However, demography and disease characteristics remained under addressed compared to patients with GBS from the developed countries. We aim to explore the demography, clinical features, electrophysiological spectrum, preceding infections/events, outcome and cost effective treatment options in a large cohort of GBS patients from Bangladesh. A total of 556 patients with GBS were enrolled from Bangladesh between 2010 and 2016 in Dhaka Medical College Hospital and National Institute of Neurosciences in Dhaka area. The diagnosis of GBS was based on the NINDS criteria. In Bangladesh GBS is a severe (median MRC; IQR = 24; 4-36) and rapidly progressive disease (median Nadir; IQR = 5; 3 – 7 days), affects relatively younger people (median Age; IQR) and most (92%) did not receive either IVIg or plasma exchange (PE). Features of a preceding infection were documented in 80% of cases, of which half had antecedent diarrhea. Cerebrospinal fluid (CSF) albuminocytologic dissociation was commonly observed (84%) and most patients (>99%) had abnormal nerve electrophysiology. As per the recently proposed Brighton criteria (BC) for GBS; 58% patients met level 1 of the BC, 28% patients met level 2, 12% patients met level 3, and 2% patients met level 4. Nerve conduction study (NCS) results were assessed in 312 patients with acute phase of GBS. Consistency of the NCS sub-classification was re-evaluated in 189 (61%) of these 312 patients within one month of the first assessment. As per the eight sets of neurophysiological criteria sets applied, half (44- 59%) of the Bangladeshi patients had an axonal subtype of GBS. Presence of anti-GM1 antibodies was strongly associated with axonal forms of GBS (55-58%); but also detected in demyelinating subtype of GBS (9-42%). Serial NCS led to change in the initial subtype classification, mainly from the demyelinating to axonal subtype, for up to one quarter (11-26%) of patients. In total, 14% of patients died and poor outcome (GBS disability score >2) was observed in 31% at 6 months from the onset of disease. Advanced age, severity of muscle weakness, pure motor involvement, need for mechanical ventilation, autonomic dysfunction, the axonal subtype and the presence of anti-GM1 or anti-LOS antibodies were independently associated with a poor outcome. Treatment with small volume plasma exchange (SVPE) was evaluated in 20 adult patients with GBS and found to be feasible and safe in resource poor setting.  In conclusion GBS in Bangladesh is severe, mostly post diarrheal pure motor axonal form and affecting young population. Most of the patients receive no immunotherapy and outcome is poor. SVPE is a safe, feasible and cost effective alternative to traditional plasma exchange or IVIg. Further studies of clinical efficacy for SVPE in low-income and middle-income countries are warranted.